Anti-Müllerian hormone is a poor predictor of pregnancy with and without assisted reproductive technology: A population-based register study of 43,269 Danish women

OBJECTIVE: Anti-Müllerian hormone (AMH) is widely used as a marker of ovarian reserve, but its predictive value for pregnancy remains uncertain. We aimed to evaluate whether pre-pregnancy AMH predicts pregnancy with or without assisted reproductive technology (ART). MATERIALS AND METHODS: This population-based register study included women aged 18-50 years from the Copenhagen Capital Region with a baseline AMH measurement between 2010 and 2022. Data were linked to national health registers via Statistics Denmark. The primary outcome was confirmed pregnancy, defined by the presence of a first-trimester biochemical screening (PAPP-A and free β-hCG). Women were stratified into subgroups based on ART (yes/no) and maternal age (<25, 25-30, 30-35, 35-40, >40 years). Associations were assessed using multivariable regression and ROC curve analysis. RESULTS: Of 43,269 women, 27,395 women had a confirmed pregnancy, and 15,874 women did not within a 3-year follow-up period after measurement of AMH. We found an overall positive association between AMH and confirmed pregnancy, adjusted for age, fertility treatment and relevant comorbidities. ROC analyses showed modest predictive value (AUC 0.50-0.69), highest in women >40 years without ART. CONCLUSION: AMH was positively associated with pregnancy but with a poor predictive value.